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Court Ruling will Impact Acupuncture Boards

The Supreme Court ruled yesterday that the North Carolina Board of Dental Examiners violated federal law when it tried to prevent non-dentists from offering teeth whitening services.

What does this have to do with acupuncture?

The ruling has the potential to impact all professional regulatory boards. I’m travelling and don’t have time or an internet connection sufficient to do a thorough report. I encourage you to click through and read the links below — I think most of you will be able to come up with a few areas where LAcs have been sounding an awful lot like those NC dentists….

“state boards composed mostly of active market participants run the risk of self-dealing.

“This conclusion does not question the good faith of state officers but rather is an assessment of the structural risk of market participants’ confusing their own interests with the state’s policy goals,” he said.

Many LAcs insist the only reason they want to stop PT’s and DC’s from doing Dry Needling is concern for the public. Could they be confused?

10 thoughts on “Court Ruling will Impact Acupuncture Boards”

“Protecting the public safety is a good reason for regulation.” Actually, public safety is the main reason for regulation. Many people are confused about the difference between a regulatory board, i.e., the California Acupuncture Board, and a certification commission/board, e.g. NCCAOM. In this context, certification boards do not exist to guarantee public safety.

IMO infections and needling accidents are under-studied. So is the volume of needling events. Even though acupuncture has its own four needling codes we do not know how many LAcs actually bill insurance. Not a popular practice among many LAcs.

Infections can result from not wearing gloves. It is naive to think LAcs carry less pathogens than other provider who perform an invasive procedure. My dentist wears gloves as does any physician who examines me. My LAc wears gloves when she withdraws the needles. She believes that is the greatest opportunity for infection.

Steve, I imagine most cases of infection occur from the needle carrying bacteria from the surface of the skin deeper. It concerns me that at least some practitioners are unaware that alcohol isn’t much of a disinfectant.

I complain plenty about groups making money off the backs of struggling LAcs. And I’m plenty unhappy with some of CCAOM’s recent actions (claiming to speak for the profession, speaking against efforts to control student debts) and inactions (not publicizing the 2014 changes to the CNT guidelines). But in this case I am not upset about what they are teaching, what they are charging, or how much they are making with the CNT course.

I’ll save my upset for the news that faculty at our accredited schools are needling through clothing and otherwise not following CNT procedures. And for the examples on Facebook of practitioners who have jumped from questioning some of the accepted truths of western medicine and science to an embrace of every far-fetched science-rejecting justification for doing whatever the heck they want to do.

Among the comments — “I watched teachers at SIOM needle through clothes often” and “I watched professors at FCIM needle . using incorrect point location on more than one occasion…”

“…market participants confusing their own interests with state policy goals.” Pretty murky water. On one hand the fact of pneumothorax and other adverse effects and on the other a militancy on individuals part that can feel deeply disingenuous. Fortunately some folks can be candid about the mixed motives. What’s the answer….? Don’t really know. Do professionals have a legitimate regarding scope of practice and fairness? Yep. Does our fear and resentment prevent us from seeing the whole picture and the long game. I think so….

Acupuncturists also are responsible for incidents of pneumothorax. And our talk of adequate training has generally been along the lines of what we have, or at least what the MD’s have to get, or, some random unsupported number that we think will be sufficiently burdensome to limit the number of people who will be willing to pursue the training.

Important to remember sense of fairness closely relates to sense of justice. To work in a system where many alternative care clinicians don’t experience this, means we often look for the culprit. In this case it’s those PT’s that are ‘stealing our art (read business in some cases) that are responsible. We have to address professional’s concerns on this level also. If we can show that abundance is closely related to generosity and grace, sometimes people become less strident. I personally can’t discard all arguments re’ public safety. I think the Observer would agree that LAc’s cause fewer pneumothoraxes than ‘weekend warriors.’ That all being said, I’m actually for training PT’s, DC’s, MD’s and anyone else with a medical degree that wants to learn. But the powers that be, have to address the parity issues and debt issues in order for LAc’s to take a step in the right direction. We’re only human and subject to all those concerns and fears, both real and made-up. “Fair to who…..?” Sometimes hard to parse that out. Power cuts in lots of directions.

I am enclosing a link to a fairly good review of ‘adverse effects’ from acupuncture based on 135 papers published in refereed journals between 1965 and 1997. There are many others but this one is quite nicely presented.

There were many problems with the selection criteria used for the review but based on the papers selected…it is important to note the following: First, pneumothorax is only one highly problematic potential complication of recklessly performed acupuncture. Secondly the number of serious adverse events associated with acupuncture may be much higher than we know because it is limited by the fact that an adequate system for reporting these does not exist. This means that many complications have never been reported. However the author concludes that acupuncture is in fact a very safe therapy when performed by adequately trained practitioners. Note however that the he states that most adverse events were “due to either lack of basic medical background or failure to apply the correct sterile techniques”. The paper itself leaves little doubt that problems with ‘sterile technique’ could have been eliminated through the use of pre-sterilized disposable needles and by following guidelines given in clean needle technique training. There were also problems associated with broken needles, implantable needles or thread, dermal and vascular reactions, moxibustion burns, and failure to exercise common sense in connection with placement of needles (for example in cases of lymphedema).

But after reviewing the evidence available in those papers the conclusion is drawn (British spellings used):

“As revealed in this survey, the majority of adverse effects related to acupuncture are due to either lack of adequate anatomic, physiologic, pharmacologic, etc. knowledge or failure to apply the proper sterile techniques, but such deficiencies can be remedied by education and personal vigilance. It also shown that serious complications can arise only; from the improper use of acupuncture or from a gross abuse by incompetent practitioner. The safety and efficacy of the technique must be judged on its results in the hands of a competent practitioner who use it properly.”

“Considering the thousands of acupuncture treatments given daily throughout the world, the number of reported side effects are remarkable low. In contrast to conventional drug and surgical therapies, the available clinical data shows substantial evidence for the high degree of safety for acupuncture. It has been demonstrated that the frequency of serious side effects are nearly three times higher among non medical trained acupuncturists compared to medical trained acupuncturists. Therefore, the need for legalisation and medical control and supervision of non medical trained acupuncturists proves to be overwhelming.”

So we should be very careful when we suggest that physicians, chiropractors, and physical therapists all of whom receive extensive anatomic and medical education are likely to be responsible for more side effects than us. If we cannot back up our claims with verifiable data we are not helping our case.

As for the this Supreme Court decision it is hard to estimate the effect this will have but I suspect it might be very great indeed. Maybe, at least, it may give those who sit on Boards, write laws, and develop regulations pause before they pursue anti-competitive agendas in their individual states. I wonder if anyone in Delaware is listening? Ehhh…probably not.